Psychiatry >
Alcohol Use & Misuse

“Long term alcohol consumption with physical and psychosocial harm causing dependence”

Risk Factors
  • Individual factors (gender, age, family) interact with external factors (culture, availability, advertising)
  • Stress
  • Depression
  • Anxiety
  • Nicotine use
  • Emotional & physical abuse
Clinical Presentation
  • Acute Intoxication:
    • Disturbed consciousness
    • Cognition
    • Perception
  • Dependence syndrome:
    • Use of substance takes on a higher priority than other behaviours that previously had greater value, positive reinforcement (alcohol = pleasurable effect) or negative reinforcement (abstinence causes neg effect, alcohol needed to relief craving
  • Withdrawal signs:
    • Increased pulse
    • Decreased BP
    • Tremor
    • Fits
    • Visual hallucinations
Investigations
  • History with Alcohol screening tool
    • For at-risk drinkers use CAGE or TWEAK screening tool
  • FBC
  • Check MVC
  • Thiamine
  • LFT
  • Hb
  • Electrolytes
Management
  • Self-help:
    • AA meetings + give disulfiram (bad reaction if alcohol is ingested reducing cravings)
  • Drugs:
    • Balance GABA and Glutamate in the brain – Anti-Glutamate (Acamprosate), Anticonvulsants (used in Detox)
    • Withdrawal: Benzodiazepine
    • Chlordiazepoxide (sed and hypnotic Benzo)
    • Cholestyramine to counteract the reduced bile outflow in Cirrhosis
    • Lactulose to help with encephalopathy
  • Treat coexisting depression
Complications
  • Organ failure:
    • Decreased albumin, Thiamine deficiency, reduced clotting factor synthesis, Ascites, Hepatitis, Fatty liver, cirrhosis, poor cognition, cerebellar atrophy, neuropathy, Korsakoff/Wernicke’s Encephalopathy, Ulcer, arrhythmia, cardiomyopathy, decreased fertility, osteoporosis, Malignancy risk, Anaemia, B12 deficiency
  • Social harm:
    • Violent crime and suicide

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